Audiovisual aids in primary healthcare settings' waiting rooms. A systematic review

Coverage of influenza, pneumococcal and zoster vaccination and determinants of influenza and pneumococcal vaccination among adults with cardiovascular diseases in community

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death and illness globally. Influenza, pneumococcal disease and herpes zoster infection may trigger acute cardiovascular events or cause complications among cardiac patients. Vaccination is recommended for adults with CVD. There is a gap in research evidence around determinants and uptake of influenza, pneumococcal and zoster vaccines in adults with CVD.

OBJECTIVE

The aim of this study is to examine the rate of the uptake of influenza, zoster and pneumococcal vaccines, factors associated with the uptake of influenza vaccine, and the perceptions of influenza and pneumococcal vaccination among people with CVD in the community.

METHOD

Cross-sectional survey data was analysed from three separate surveys carried out in Australia between October 2019 and September 2020 of 972 adults with CVD. We used descriptive statistics to describe data. Thematic analysis examined the reasons for taking influenza vaccine. Multivariable analysis was used to identify independent predictors of the influenza vaccine uptake and perceptions associated with the uptake of influenza and pneumococcal vaccines.

RESULTS

Out of 972 participants, a total of 661 (68 %) people said they had received influenza vaccine in the last 12 months; 361 (37 %) had ever received pneumococcal vaccine; 196 (20 %) had ever received zoster vaccine. Among 661 participants who said they received influenza vaccine within the 12 months prior to the study, 543 (82 %) participants received it from doctors or general practitioners (GPs) offices. Age 65 and older, being born in Australia, being employed or retired and having comorbidity were positive predictors of influenza vaccination. Doctors' recommendations to take the vaccine and awareness of free vaccines positively predicted influenza and pneumococcal vaccine uptake.

CONCLUSION

The uptake of recommended pneumococcal and zoster vaccines is low in people with CVD. Doctors' recommendations, targeted health promotion programs in general practice, and easy access to vaccination may optimise vaccination uptake in patients with CVD.

Digital screens in community pharmacy for public health messaging; a mixed-methods study

OBJECTIVES

An independent evaluation was undertaken to investigate the perceived impact of installing digital screens in a group of community pharmacies as an approach to provide public health messaging.

METHODS

Community pharmacy staff were interviewed prior to screen installation to investigate experience and perceptions of conventional public health campaigns using written materials. Staff were interviewed after the digital screen installation to investigate their opinions of the installation and its impact on public health delivery in the pharmacy. Patients and public representatives were recruited to visit the pharmacies and asked to complete a survey about what they observed and thought about the public health messaging. Interviews were transcribed verbatim and thematically analysed. Surveys consisted of open, closed, and rating questions. The results of which were descriptively analysed.

KEY FINDINGS

Community pharmacy staff found paper-based campaigns work-intensive and created paper wastage. The digital screen installation was received positively by pharmacy staff and patient, and public representatives found them eye-catching and engaging. Staff were unable to report any conversations with members of the public triggered by the screens, but the patient and public volunteers were able to recall some of the health messages.

CONCLUSIONS

Digital messaging is common practice and digital screens are already in use in areas where patients and the public have conventionally been in attendance, e.g. GP surgeries. Digital screens in community pharmacy for public health messaging could be considered an inevitable progression for public health messaging given concerns about wastage and up-to-date information. The impact, however, on triggering healthier choices and lifestyles requires further investigation.

Engagement and fidelity of a cardiovascular disease prevention-focused digital health intervention in cardiology outpatient waiting rooms: a mixed-methods study

INTRODUCTION

We delivered a video-based, cardiovascular disease prevention focused intervention in cardiology waiting rooms that increased motivation to improve cardiovascular risk behaviours and satisfaction with clinic services. To better understand the potential generalisability and scalability of such waiting room interventions, this study evaluated the fidelity of intervention delivery and barriers and enablers to implementation.

METHODS

Mixed-methods process evaluation conducted among intervention participants in a randomised clinical trial. Data sources included (1) Participant screening logs, (2) Intervention delivery platform data and (3) Semi structured interviews performed with participants. Qualitative data were described using inductive thematic analysis.

RESULTS

The tablet-based intervention was delivered to 220 patients (112 (50.9%) male, mean age 54.2 (SD 15.4) years). Of 765 videos opened, 636 (83.1%) were watched to completion. Most videos opened were rated (738/765, 96.5%) and video ratings were predominantly positive (661/738, (89.6%) satisfied or highly satisfied). Younger and more educated participants were more likely to rate videos highly (relative risk (RR) 1.73 (95% CI 1.28 to 2.32) and RR 1.26 (95% CI 1.07 to 1.49)) but less likely to watch videos to completion (younger: RR 0.27 (95% CI 0.17 to 0.43), more educated: RR 0.90 (95% CI 0.85 to 0.96)). Of 39 invited, 21 (53.8%) participated in semistructured interviews. Thematic analysis of responses suggested reported behaviour change post intervention may be due to increased awareness of cardiovascular risk, reduced anxiety and intrinsic motivation from delivery within a cardiology waiting room. Lack of reinforcement and limited personalisation were barriers.

CONCLUSION

The current analysis demonstrates that engagement with a digitally delivered clinic waiting room educational intervention was high, providing explanation for its efficacy in improving motivation to change cardiovascular risk behaviours. The high fidelity of delivery demonstrates potential for scaling of such interventions across waiting rooms. Recall bias and low response rate may bias self-reported engagement measures.

TRIAL REGISTRATION NUMBER

ANZCTR12618001725257.

Do health service waiting areas contribute to the health literacy of consumers? A scoping review

Health service waiting areas commonly provide health information, resources and supports for consumers; however, the effect on health literacy and related outcomes remains unclear. This scoping review of the literature aimed to explore the use of waiting areas as a place to contribute to the health literacy and related outcomes of consumers attending health appointments. Articles were included if they focussed on health literacy or health literacy responsiveness (concept) in outpatient or primary care health service waiting areas (context) for adult consumers (population) and were published after 2010. Ten bibliographic databases, one full-text archive, dissertation repositories and web sources were searched. The search yielded 5095 records. After duplicate removal, 3942 title/abstract records were screened and 360 full-text records assessed. Data were charted into a standardized data extraction tool. A total of 116 unique articles (published empirical and grey literature) were included. Most articles were set in primary and community care (49%) waiting areas. A diverse range of health topics and resource types were available, but results demonstrated they were not always used by consumers. Outcomes measured in intervention studies were health knowledge, intentions and other psychological factors, self-reported and observed behaviours, clinical outcomes and health service utilization. Intervention studies overall demonstrated positive trends in health literacy-related outcomes, although the benefit declined after 3-6 months. Research on using waiting areas for health literacy purposes is increasing globally. Future research investigating the needs of consumers to inform optimal intervention design is needed.

Exploring Customer Journeys in the Context of Dentistry: A Case Study

This case study aims to explore how customer journey concepts can apply to a hypothetical scenario, centring on a patient (customer persona) within the dentistry arena, and with a particular focus on special care dentistry. As an educational exercise, this paper may inform dental and allied professionals on how aspects of the customer journey notion may be embedded into their own practices, so that patient-centricity might be better optimised. The hypothetical scenario considers the organisational context, customer persona, contemporary customer purchase decision-making models, and marketing approaches. These components are used to create a customer journey map to help visualise and identify the varying customer–business interactions. The customer journey, focussing on the awareness, initial consideration, active evaluation, pre-purchase, purchase and post-purchase stages, is then conceptually analysed. The analyses reveal that there are areas of friction, attributable to numerous factors. The case study recommends that by introducing digitalisation and omnichannel marketing, alongside existing internally generated and multi-channel marketing approaches, considerable improvements may be achievable. As the patient technology landscape becomes more digital and dental organisations face fiercer competition, dental care providers relying on traditional marketing approaches may well need to adapt and introduce innovative, yet cost-effective digitalisation and omnichannel marketing approaches. Nevertheless, dental care providers, and dental and allied professionals must uphold an underlying duty of care, ensuring that all practises are legal, decent, honest, truthful, and above all ethical.

Impact of Socio-demographic Characteristics on Time in Outpatient Cardiology Clinics: A Retrospective Analysis

Inequitable access to health services influences health outcomes. Some studies have found patients of lower socio-economic status (SES) wait longer for surgery, but little data exist on access to outpatient services. This study analyzed patient-level data from outpatient public cardiology clinics and assessed whether low SES patients spend longer accessing ambulatory services. Retrospective analysis of cardiology clinic encounters across 3 public hospitals between 2014 and 2019 was undertaken. Data were linked to age, gender, Indigenous status, country of birth, language spoken at home, number of comorbidities, and postcode. A cox proportional hazards model was applied adjusting for visit type (new/follow up), clinic, and referral source. Higher hazard ratio (HR) indicates shorter clinic time. Overall, 22 367 patients were included (mean [SD] age 61.4 [15.2], 14 925 (66.7%) male). Only 7823 (35.0%) were born in Australia and 8452 (37.8%) were in the lowest SES quintile. Median total clinic time was 84 min (IQR 58-130). Visit type, clinic, and referral source were associated with clinic time (R² = 0.23, 0.35, 0.20). After adjusting for these variables, older patients spent longer in clinic (HR 0.94 [0.90-0.97]), though there was no difference according to SES (HR 1.02 [0.99-1.06]) or other variables of interest. Time spent attending an outpatient clinic is substantial, amplifying an already significant time burden faced by patients with chronic health conditions. SES was not associated with longer clinic time in our analysis. Time spent in clinics could be used more productively to optimize care, improve health outcomes and patient experience.

Impact of promoting blood donation in general practice: Prospective study among blood donors in France

Introduction

Waiting rooms in general practitioners' (GP) surgeries are a potentially useful site for spreading educational messages about health behaviors. We aimed to evaluate the impact of posters displayed in GPs' waiting rooms on the number of donors attending the blood donation drives in the Aube Department of France. The secondary objective was to identify self-reported factors that incited people to give blood among donors who did and donors who did not see the posters.

Methods

Observational, multicenter, prospective study, from 1 June to 31 December 2021. Six blood donation centers in the Aube Department were selected. All GPs located within a 15 km radius around each center were invited to participate by hanging posters advertising blood drives in their waiting rooms. The number of blood donations per hour was measured before and during the campaign. Factors prompting people to give blood were evaluated by questionnaires completed by persons attending the blood drives.

Results

33 GPs participated. The number of donations per hour was lower in the year in which the posters were displayed (2021) compared to the previous year (12 vs. 15). A total of 1,469 questionnaires were completed by blood donors: 729 reported having seen the posters, and 740 reported not having seen the posters. Those who claimed to have seen the posters were more likely than those who claimed not to have seen the posters to respond that in parallel, they had been prompted to give blood via online publicity (7.5 vs. 3.9%, adjusted Odds ratio [aOR] 1.75, 95% confidence interval [CI] 1.12-2.82, p = 0.02). They also more often reported that they had been prompted to donate by television advertisements (8.0 vs. 4.2%, aOR 1.74, 95%CI 1.10-2.76, p = 0.02). Overall, 68% of all respondents indicated that posters in the GP's waiting room would incite them to give blood more often.

Conclusion

The number of blood donations per hour was lower during the year in which posters were displayed. Questionnaire data from donors suggests that promoting blood donation via posters in GPs' waiting rooms could have a positive effect: 68% of donors claimed that posters would incite them to give blood.

Defining and evaluating the Hawthorne effect in primary care, a systematic review and meta-analysis

In 2015, we conducted a randomized controlled trial (RCT) in primary care to evaluate if posters and pamphlets dispensed in general practice waiting rooms enhanced vaccination uptake for seasonal influenza. Unexpectedly, vaccination uptake rose in both arms of the RCT whereas public health data indicated a decrease. We wondered if the design of the trial had led to a Hawthorne effect (HE). Searching the literature, we noticed that the definition of the HE was unclear if stated. Our objectives were to refine a definition of the HE for primary care, to evaluate its size, and to draw consequences for primary care research. We designed a Preferred Reporting Items for Systematic reviews and Meta-Analyses review and meta-analysis between January 2012 and March 2022. We included original reports defining the HE and reports measuring it without setting limitations. Definitions of the HE were collected and summarized. Main published outcomes were extracted and measures were analyzed to evaluate odds ratios (ORs) in primary care. The search led to 180 records, reduced on review to 74 for definition and 15 for quantification. Our definition of HE is "an aware or unconscious complex behavior change in a study environment, related to the complex interaction of four biases affecting the study subjects and investigators: selection bias, commitment and congruence bias, conformity and social desirability bias and observation and measurement bias." Its size varies in time and depends on the education and professional position of the investigators and subjects, the study environment, and the outcome. There are overlap areas between the HE, placebo effect, and regression to the mean. In binary outcomes, the overall OR of the HE computed in primary care was 1.41 (95% CI: [1.13; 1.75]; I 2 = 97%), but the significance of the HE disappears in well-designed studies. We conclude that the HE results from a complex system of interacting phenomena and appears to some degree in all experimental research, but its size can considerably be reduced by refining study designs.

Reanalysis of a Randomized Controlled Trial on Promoting Influenza Vaccination in General Practice Waiting Rooms: A Zelen Design

In 2014–2015, we conducted a randomized controlled trial (RCT) assessing the effect of an advertising campaign for influenza vaccination using posters and pamphlets in general practitioner (GP) waiting rooms. No effect of the intervention could be demonstrated, but the immunization uptake increased in both arms of the study. In 2019, we deepened the investigations explaining the increased uptake conducting a registry-based 4/2/1 cluster RCT designed by Zelen with two extra years of follow-up of the study cohort. The study population included 23,024 patients eligible to be vaccinated who were registered with 175 GPs. The main outcome remained the number of vaccination units delivered per study group. Data were extracted from the SNIIRAM warehouse claim database for the Lille-Douai district (northern France). No difference in vaccination uptake was found in the Zelen versus the control group of the initial RCT. Overall, the proportion of vaccinated patients increased in the cohort from 51.4% to 70.4% over the three years. Being vaccinated the previous year was a strong predictor of being vaccinated in a subsequent year. The increase in vaccination uptake, especially among people older than 65, can be explained by a cohort effect. Health promotion and the promotion of primary health care may play an important role in this increase.

Perspectives of health and community stakeholders on community-delivered models of malaria elimination in Lao People’s Democratic Republic: A qualitative study

In the Lao People’s Democratic Republic (Lao PDR), village health volunteers play an important role in providing health services including those to reduce the burden of malaria. Over the last two decades, the volunteer network has expanded to bring malaria services closer to communities and contributed to the reduction of malaria cases. However, as malaria test positivity rates decreased, many volunteers have lost motivation to continue providing routine malaria services, and other services they provide may not reflect growing healthcare demands for common diseases in the community. This study explored the perspectives, knowledge and inputs of key health stakeholders and community members in southern Lao PDR on community-delivered models in order to refine the volunteer model in the context of Lao PDR’s primary health care sector and malaria elimination goals. Semi-structured interviews with multi-level health stakeholders, participatory workshops with community leaders, and focus group discussions with community members and current village health volunteers were conducted. Deductive followed by inductive thematic analysis was used to explore and categorise stakeholders’ perspectives on community-delivered models for malaria elimination. Both stakeholders and community members agreed that village health volunteers are essential providers of malaria services in rural communities. Apart from malaria, community members identified dengue, diarrhoea, influenza, skin infections and tuberculosis as priorities (in descending order of importance) and requested community-based primary health care for these diseases. Stakeholders and community members suggested integrating prevention, diagnosis, and treatment services for the five priority diseases into the current malaria volunteer model. A divergence was identified between community members’ expectations of health services and the services currently provided by village health volunteers. Stakeholders proposed an integrated model of healthcare to meet the needs of the community and help to maintain volunteers’ motivation and the long-term sustainability of the role. An evidence-based, integrated community-delivered model of healthcare should be developed to balance the needs of both community members and stakeholders, with consideration of available resources and current health policies in Lao PDR.

Seeking Choice to Fulfill Health Literacy Needs: Health Literacy Opportunities for Consumers in Hospital Waiting Areas

In this research, we explore and theorize on the potential of hospital outpatient rehabilitation waiting areas to respond and contribute to the health literacy needs of consumers. Constructivist grounded theory informed the sampling and analytical procedures. Thirty-three consumers attending outpatient rehabilitation for a range of health conditions were recruited to this multi-site study. Semi-structured interview and participant observation data were collected and analyzed concurrently using the constant comparison method. The substantive theory of "seeking choice to fulfill health literacy needs" and five interdependent categories were developed. Results indicated that consumers sought choice reflective of their needs; however, the waiting area offered limited choice. Consumers shared ideas to address the lack of choice. Results provide insight into the health literacy needs of consumers in hospital outpatient waiting areas and how health services can appropriately respond to these needs. Future research should investigate the effect of health service environments on health outcomes.

You're Worried, We're Listening: Online Testing of the Effectiveness of Education Materials to Improve Consumer Knowledge and Confidence in Reporting Patient Deterioration

OBJECTIVES

Early identification of patient deterioration in hospital is important to reduce mortality, avoidable morbidity, length of stay, and associated healthcare costs. By closely observing physical and behavioral changes, deteriorating patients are more likely to be identified. Patients and family at the bedside can play an important role in reporting deterioration if made aware of how to do so. Therefore, the objective of this study was to undertake an online evaluation of educational materials designed to improve consumers' knowledge and confidence to report patient deterioration.

METHODS

A convenience sample was used to recruit community-based participants for an online survey. A self-designed validated instrument was used to undertake a preintervention and postintervention test involving 3 types of educational materials. Quantitative data were analyzed with Wilcoxon signed rank test to compare participants' knowledge and confidence before and after exposure to the intervention. Conventional content analyses examined responses on key messages and recommendations to improve the educational materials.

RESULTS

A total of 84 respondents completed both prequestionnaires and postquestionnaires. After exposure to the education materials, analyses confirmed that knowledge and confidence scores were significantly higher than baseline measures. Content analyses indicated a clear understanding of the key messages presented in the materials. Four main recommendations were made regarding the education materials.

CONCLUSIONS

Participants readily identified the key messages in the educational materials and demonstrated increased knowledge and confidence to report concerns about deterioration. Further research is required to determine the efficacy of the educational materials in relation to consumer behavior.

Effect of a waiting room communication strategy on imaging rates and awareness of public health messages for low back pain

BACKGROUND

Few studies have investigated the effects of waiting room communication strategies on health-care behavior.

OBJECTIVE

We aimed to determine the effect of a waiting room communication strategy, designed to raise awareness of potential harms of unnecessary imaging, on lumbar imaging rates in the emergency department (ED).

METHODS

We conducted a controlled experimental study with a replicated time series design. The design included a 6-week run-in time. Following this there were alternating 1-week intervention and control periods. The intervention group received a communication strategy describing the potential harms of unnecessary imaging for low back pain, shown on a 55" LCD screen positioned in the ED waiting room. The communication strategy was designed by a creative innovation agency and included five digital posters and a patient leaflet. The control group received standard messaging for the waiting room at the time, shown on the same 55" LCD screen, and access to the patient leaflet. The primary outcome was the number and proportion of people presenting to ED with low back pain who received at least one lumbar imaging test, measured using routinely collected ED data. Secondary patient-reported outcomes (patient satisfaction and awareness of campaign messages) were collected from a sample of people presenting for any condition who responded to a text-message-based survey.

RESULTS

For the imaging outcome, 337 people presenting to ED with low back pain were included over a 4-month period (intervention n = 99; control n = 238). All had available data on lumbar imaging. Use of lumbar imaging was 25% in those exposed to the communication strategy [95% confidence interval (CI) = 18% to 35%] compared with 29% in those exposed to the standard waiting room messaging [95% CI = 23% to 35%; odds ratio (OR) = 0.83, 95% CI = 0.49 to 1.41]. For the patient-reported outcomes, 349 patients presenting to ED for any condition responded to the survey (intervention n = 170; control n = 179; response rate = 33%). There was uncertain evidence that the intervention increased awareness of the communication strategy leaflet (OR = 2.00, 95% CI = 0.90 to 4.47). Other measures did not suggest between-group differences in patient satisfaction or awareness of the campaign messages.

CONCLUSION

A communication strategy displayed in the ED waiting room may slightly reduce the proportion of patients with low back pain who receive lumbar imaging, although there is uncertainty due to imprecision. The campaign did not appear to increase awareness of campaign messages or affect patient satisfaction in a sample of patients presenting to the ED for any reason. Larger studies should investigate whether simple, low-cost waiting room communication strategies can raise awareness of unnecessary healthcare and influence health-care quality.

TRIAL REGISTRATION

ACTRN12620000300976, 05/03/2020.

Knowledge of congenital CMV, risk behaviours for CMV acquisition, and acceptance of an educational infographic among postpartum women: a pilot study

Congenital cytomegalovirus (cCMV) infection in the newborn can present with sensorineural hearing loss and microcephaly. The objectives of this study were to determine baseline knowledge of cCMV and the acceptability of an infographic about cCMV among a group of postpartum women. Participants completed a questionnaire assessing their perceptions of an infographic as well as their knowledge and risk behaviours for acquisition of CMV. Of all 140 respondents, 119 (85%) had no prior knowledge of cCMV, and all 12 women (8.6%) who viewed the infographic indicated that it was helpful. Our study also demonstrated that passive dissemination of an infographic in clinics results in limited viewership.

Determinants of Influenza Vaccine Uptake in Patients With Cardiovascular Disease and Strategies for Improvement

Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Influenza infection is associated with an increased risk of cardiovascular events (myocardial infarction, stroke, and heart failure exacerbation) and mortality, and all‐cause mortality in patients with CVD. Infection with influenza leads to a systemic inflammatory and thrombogenic response in the host body, which further causes destabilization of atherosclerotic plaques. Influenza vaccination has been shown to be protective against cardiovascular and cerebrovascular events in several observational and prospective studies of at‐risk populations. Hence, many international guidelines recommend influenza vaccination for adults of all ages, especially for individuals with high‐risk conditions such as CVD. Despite these long‐standing recommendations, influenza vaccine uptake among US adults with CVD remains suboptimal. Specifically, vaccination uptake is strikingly low among patients aged <65 years, non‐Hispanic Black individuals, those without health insurance, and those with diminished access to healthcare services. Behavioral factors such as perceived vaccine efficacy, vaccine safety, and attitudes towards vaccination play an important role in vaccine acceptance at the individual and community levels. With the ongoing COVID‐19 pandemic, there is a potential threat of a concurrent epidemic with influenza. This would be devastating for vulnerable populations such as adults with CVD, further stressing the need for ensuring adequate influenza vaccination coverage. In this review, we describe a variety of strategies to improve the uptake of influenza vaccination in patients with CVD through improved understanding of key sociodemographic determinants and behaviors that are associated with vaccination, or the lack thereof. We further discuss the potential use of relevant strategies for COVID‐19 vaccine uptake among those with CVD.

The Display of Medical Information: Content, Format, and Subjective Experience

OBJECTIVES

To address a gap in the literature by investigating the subjective experience of participants to the form and content of medical information displayed in a healthcare setting.

BACKGROUND

Artwork can enhance the experience of patients, but much less is known about how individuals react to displays of medical information in the form of posters or pamphlets, especially those about unsettling conditions (e.g., skin cancer).

METHODS

In a 2 × 2 × 2 between-subjects design, researchers investigated the content of medical information (skin cancer vs. skin care) that was on display in a simulated exam room, whether the form was a pamphlet or a poster, and reason for the visit (routine annual skin check or evaluating a mole) on measures of subjective experience, including anxiety.

RESULTS

Viewing material about skin cancer produced greater anxiety and greater arousal than did viewing material about sunscreen, and given the choice of four images (pamphlet and poster for sunscreen, pamphlet and poster for skin cancer), the sunscreen poster was recommended to improve the patient's experience and lower stress. In terms of display format, posters are judged to provide more visual engagement than are pamphlets.

CONCLUSIONS

Exam rooms should offer multiple opportunities for visual engagement without images that produce anxiety. More research is needed to understand the subjective experience of the patient's interaction with the content and format of medical information.

Educational Video Improves Knowledge about Outpatients' Usage of Antibiotics in Two Public Hospitals in Indonesia

The inappropriate use or misuse of antibiotics, particularly by outpatients, increases antibiotic resistance. A lack of public knowledge about "Responsible use of antibiotics" and "How to obtain antibiotics" is a major cause of this. This study aimed to assess the effectiveness of an educational video about antibiotics and antibiotic use to increase outpatients' knowledge shown in two public hospitals in East Java, Indonesia. A quasi-experimental research setting was used with a one-group pre-test-post-test design, carried out from November 2018 to January 2019. The study population consisted of outpatients to whom antibiotics were prescribed. Participants were selected using a purposive sampling technique; 98 outpatients at MZ General Hospital in the S regency and 96 at SG General Hospital in the L regency were included. A questionnaire was used to measure the respondents' knowledge, and consisted of five domains, i.e., the definition of infections and antibiotics, obtaining the antibiotics, directions for use, storage instructions, and antibiotic resistance. The knowledge test score was the total score of the Guttman scale (a dichotomous "yes" or "no" answer). To determine the significance of the difference in knowledge before and after providing the educational video and in the knowledge score between hospitals, the (paired) Student's t-test was applied. The educational videos significantly improved outpatients' knowledge, which increased by 41% in MZ General Hospital, and by 42% in SG General Hospital. It was concluded that an educational video provides a useful method to improve the knowledge of the outpatients regarding antibiotics.

"I would not go to him": Focus groups exploring community responses to a public health campaign aimed at reducing unnecessary diagnostic imaging of low back pain

BACKGROUND

Community awareness of the harms of overdiagnosis remains low.

OBJECTIVE

To evaluate community responses to a public health campaign designed for health service waiting rooms that focuses on the harms of unnecessary diagnostic imaging for low back pain.

METHODS

We conducted two focus groups of 19 community members with or without low back pain in Sydney, Australia. This study formed the fourth and final stage of the development process of a public health campaign: (a) initial design, (b) expert review and revision, (c) online experiment and (d) community views & revision. We evaluated reactions to components of the campaign that included digital posters and an information leaflet using strong imagery and messaging about the risk of overdiagnosis. We conducted a qualitative thematic analysis to identify main themes.

RESULTS

Community members reacted with surprise, initial mistrust, and occasionally anger towards imagery and messaging that suggested diagnostic imaging tests could be unnecessary and harmful. With further reflection and discussion, and after reading longer format information about overdiagnosis, the participants found some of the messages informative and useful. Participants appeared to gain a better understanding of the concept of overdiagnosis and the importance of not rushing to imaging.

CONCLUSIONS

Public health campaigns including posters and leaflets displayed in waiting rooms could raise awareness about overuse of diagnostic imaging and the harms of overdiagnosis more broadly. However, negative reactions are possible and must be managed carefully.

PATIENT OR PUBLIC CONTRIBUTION

We involved a community participation manager who provided advice on the focus group discussion guide, participant recruitment and manuscript presentation.

Tablet-based patient educational interventions in care and management of complex movement disorders

BACKGROUND

Patient education is an essential part of management of complex, disabling neurological disorders. Mobile web-based educational materials provide a novel and potentially valuable means to communicate clinical information that can aid in both medical management and rehabilitation.

AIMS

We, therefore, evaluated an educational tablet-based intervention in three patient cohorts regarding the following topics: Parkinson's disease (PD) medications, dystonia and botulinum toxin treatment.

METHODS

A total of 50 subjects with PD, 32 with dystonia and 61 receiving botulinum toxin treatment for movement disorders or sialorrhoea were enrolled. Participants in each cohort completed a specific educational module at the time of their regularly scheduled clinic visit, comprising slides, in addition to pre- and post-module quizzes and a satisfaction survey. Additionally, participants in the dystonia and botulinum toxin modules were given a follow-up test at their 3- or 6-month clinical treatment visit.

RESULTS

There were 143 participants with 50 completing the PD module, 32 completing the dystonia module and 61 completing the botulinum toxin module. All three groups demonstrated significant improvement in knowledge of module content between their pre- and post-module test scores (PD: p=.0001, dystonia: p<.0001 and botulinum toxin: p=.008), and those who took the dystonia module maintained significant improvement at either a 3- or 6-month follow up compared to pre-module (p <.0001).

CONCLUSIONS

Tablet-based teaching modules are an effective means of communicating key concepts to patients. This study supports their use for improving patient understanding that can support lifelong approaches to managing disabling, neurological conditions.Implication for RehabilitationTablet-based modules are relatively easy to use for enhancing education during clinic visits and can possibly help reduce and maintain disability with chronic conditions like Parkinson's disease and dystonia.Improvements in post-test scores suggested that patient participants were able to retain information from the tablets about their complex and challenging conditions and treatments.Adding patients who are fluent in another language would have made this study more generalizable and future studies exploring educational interventions are warranted to help better tailor interventions to patients with chronic neurologic illnesses to help understand the complex aspects of their medical and rehabilitation therapy.The effect of cognitive changes in neurological conditions and understanding of educational information needs to be further tested.This positive result is especially meaningful during the COVID-19 pandemic when in-person access to both medical and rehabilitative care has been curtailed.

An Integrated Guide for Designing Video Abstracts Using Freeware and Their Emerging Role in Academic Research Advancement

Video abstracts (VAs) are a motion picture equivalent of written abstracts. With greater use of social media platforms for post publication promotions of research articles, VAs have gained increasing popularity among researchers in recent years. Widespread lockdowns and social distancing protocols in the pandemic period furthered the use of VAs as a tool for efficient learning. Moreover, these may be the preferred medium for communicating certain types of information, such as diagnostic or therapeutic procedures, qualitative research, perspectives, and techniques. In this article, the authors discuss the role of VAs in the advancement of academic research, plausible designs, freeware for making videos, and specific considerations for crafting good VAs.

While you're waiting, a waiting room-based, cardiovascular disease-focused educational program: protocol for a randomised controlled trial

INTRODUCTION

Patients with cardiovascular disease (CVD) frequently attend outpatient clinics and spend a significant amount of time in waiting rooms. Currently, this time is poorly used. This study aims to investigate whether providing CVD and cardiopulmonary resuscitation (CPR) education to waiting patients in a cardiology clinic of a large referral hospital improves motivation to change health behaviours, CPR knowledge, behaviours and clinic satisfaction post clinic, and whether there is any impact on reported CVD lifestyle behaviours or relevant CPR outcomes at 30 days.

METHODS AND ANALYSIS

Randomised controlled trial with parallel design to be conducted among 330 patients in the waiting room of a chest pain clinic in a tertiary referral hospital. Intervention (n=220) participants will receive a tablet-delivered series of educational videos catered to self-reported topics of interest (physical activity, blood pressure, diet, medications, smoking and general health) and level of health knowledge. Control (n=110) participants will receive usual care. In a substudy, intervention participants will be randomised 1:1 to receive an extra video on CPR or no extra video. The primary outcome will be the proportion of intervention and control participants who report high motivation to improve physical activity, diet and blood pressure monitoring at end of clinic. The primary outcome of the CPR study will be confidence to perform CPR post clinic. Secondary analysis will examine impact on clinic satisfaction, lifestyle behaviours, CPR knowledge and willingness to perform CPR post clinic and at 30-day follow-up.

ETHICS AND DISSEMINATION

Ethics approval has been received from the Western Sydney Local Health District Human Research Ethics Committee. All patients will provide informed consent via a tablet-based eConsent framework. Study results will be disseminated via the usual channels including peer-reviewed publications and presentations at national and international conferences.

TRIAL REGISTRATION NUMBER

ANZCTR12618001725257.